Does left atrial strain assessed by echocardiography correlate with atrial fibrosis detected by invasive voltage mapping in patients undergoing AF ablation?
Left atrial reservoir strain assessed by echocardiography correlates strongly with fibrotic burden identified by invasive voltage mapping, suggesting its utility as a noninvasive marker for atrial fibrosis.
Abstract Background Atrial fibrosis represents the structural substrate underlying atrial fibrillation (AF) maintenance and recurrence after catheter ablation (CA). Low-voltage areas (LVAs) identified during electroanatomical voltage mapping accurately reflect fibrotic remodeling and provide an invasive marker for substrate characterization. Left atrial (LA) strain assessed by speckle-tracking echocardiography offers a noninvasive evaluation of atrial compliance and function, potentially serving as a surrogate marker for atrial fibrosis. Purpose To evaluate the relationship between echocardiographic LA strain parameters and the extent of fibrosis detected by voltage mapping in patients undergoing high-power short-duration (HPSD) CA for AF. Methods Twenty-eight consecutive AF patients (67.9% male, mean age 64 ± 7.9 years) were prospectively enrolled. Paroxysmal AF was present in 39.3% and persistent in 60.7%. Mean LA diameter was 45 ± 7.2 mm and LA volume 84.9 ± 29.4 mL. LA reservoir and contraction strain were assessed by 2D speckle-tracking (mean values 18.6 ± 10.9% and 7.6 ± 6.7%, respectively). During ablation, voltage maps were acquired, and LVAs (0.5 mV) were considered fibrotic. Fibrosis was identified in 10 patients (35.7%), with a mean area of 4.1 ± 8.5 cm². Results Reduced LA reservoir strain correlated with lower contraction strain (R = 0.44, p = 0.02), higher LA volume (R = 0.68, p 0.001), and larger fibrosis area (R = 0.59, p = 0.01). Contraction strain also correlated with LA volume (R = 0.68, p 0.001) and fibrosis (R = 0.48, p = 0.08). Patients with LVAs had significantly lower LA reservoir and contraction strain compared with those without fibrosis. Conclusion Left atrial strain, particularly reservoir strain, shows a strong relationship with fibrotic burden assessed by voltage mapping during AF HPSD CA. Echocardiographic strain analysis offers a simple, reproducible, and noninvasive tool for estimating atrial fibrosis. Incorporating LA strain into pre-ablation evaluation may improve patient selection, procedural planning, and prediction of ablation outcomes in atrial fibrillation.
Minciuna et al. (Mon,) studied this question.